Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique Zimmer Nail

2016-04-01

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Zimmer®
Natural Nail®
System
Antegrade Femoral Nail
Surgical Technique
(Piriformis Fossa & Greater Trochanteric Approaches)
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 1
Zimmer
Natural Nail System
Antegrade Femoral Nail
Surgical Technique
Table of Contents
Product Overview 2
Implant Overview 2
Indications 3
Contraindications 3
Surgical Technique 3
Preoperative Planning 3
Patient Positioning 3
Reduction 3
Greater Trochanter Entry Point 4
Piriformis Fossa Entry Point 5
Proximal Reaming 7
Shaft Reaming 8
Nail Assembly and Insertion 8
Greater Trochanter Entry Point Nail Insertion 9
Piriformis Fossa Entry Point Nail Insertion 9
Proximal Screw Placement 11
Distal Targeting – Freehand Technique 15
Finalize Implant Placement 16
Postoperative Care 16
Nail Extraction 16
Antegrade Femur PF Nail Details 17
Antegrade Femur GT Nail Details 18
Case Examples 20
Product Information 21
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
2
Product Overview
The Zimmer® Natural Nail® System
is a system of intramedullary (IM)
nails, screws, instruments and other
associated implants that are designed
to provide stable internal fixation for
fractured long bones. The nails have
been designed for specific applications
to help restore the shape of the fractured
bone to its natural, pre-injured state.
The Antegrade Femur nails are designed
to help treat various fractures of the
femur. Different nails are available to
be placed through the tip of the Greater
Trochanter or through the Piriformis
Fossa. Screws are placed through the
nail to secure the implant in place and
maintain length and alignment while
healing occurs. The nails have multiple
screw holes in the proximal body to allow
surgeons to address different fracture
types. Proximal and distal slots allow for
compression or dynamization across
a fracture.
Implant Overview
Greater Trochanter
Nail Diameters: 8.3, 9.3, 10, 11, 12, 13, 14mm
Nail Lengths: 8.3mm, 24 to 40cm in 2cm increments
9.3mm and larger, 24 to 48cm in 2cm increments
CCD Angle: 132°
Piriformis Fossa
Nail Diameters: 9.3, 10, 11, 12, 13, 14, 15mm
Nail Lengths: 24 to 48cm in 2cm increments
CCD Angle: 128° Universal
Proximal Screw Diameters
5.0mm for transverse holes (with Stabilize Technology)
6.0mm for Recon/Descending holes
Distal Screw Diameters (with Stabilize Technology)
4.0mm for 8.3mm nails
5.0mm for 9.3mm and larger nails
Screw Lengths
4.0mm: 20 to 60mm in 2.5mm increments
65 to 100mm in 5mm increments
5.0mm: 20 to 60mm in 2.5mm increments
65 to 100mm in 5mm increments
6.0mm: 50 to 140mm in 5mm increments
Screws available in fully- and partially-threaded configurations.
Materials: Ti-6Al-4V alloy
Precision instrumentation is provided
to help implant the nail. Many of the
instruments and implants feature a
color coding system to help the surgical
team use the system. Certain universal
instruments are not color coded. The
color coding system is referenced in the
technique. A wall chart (97-2491-003-
00) is also available to help explain the
color coding system.
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 3
Indications
The Zimmer Natural Nail system is
indicated for temporary fracture fixation
and stabilization of the bone.
Indications for use of the Greater
Trochanter and Piriformis Fossa nails in
the femur include:
• Compound and simple shaft fractures
• Proximal, metaphyseal and distal
shaft fractures
• Segmental fractures
• Comminuted fractures
• Fractures involving osteopenic and
osteoporotic bone
• Pathological fractures
• Fractures with bone loss
• Pseudoarthrosis, non-union,
mal-union and delayed union
• Periprosthetic fractures
• Surgically created defects such
as osteotomies
• Intertrochanteric and subtrochanteric
fractures
Contraindications
• A medullary canal obliterated by a
previous fracture or tumor
• Bone shaft having excessive bow or
deformity
• Lack of bone substance or bone
quality which makes stable seating of
the implant impossible
• All concomitant diseases that can
impair the functioning and the success
of the implant
• Infection
• Insufficient blood circulation
• Skeletally immature patients
WARNING: This nail should only be used
to treat a periprosthetic fracture if the in
situ device is firmly fixed. When treating
a periprosthetic fracture, the nail should
be positioned so that it does not come in
contact with the in situ device.
Surgical Technique
Preoperative Planning
Preoperative planning is recommended
before beginning the surgical procedure.
A/P and Lateral x-rays of the injured
femur should be taken preoperatively
and evaluated for length, canal size
and implant suitability. A/P and Lateral
x-rays of the contralateral uninjured
femur can also be taken preoperatively
to provide insight into the characteristics
of the pre-injured femur.
Patient Positioning
The patient should be positioned in
either a lateral or supine position. If
positioned in a supine position, a bump
should be placed under the hip of the
injured femur to elevate it slightly. The
use of a fracture table can be beneficial
to help during fracture reduction as well
as to facilitate intraoperative imaging
with a C-arm. The C-arm should be placed
to allow for imaging of the femur in
both planes along the entire length of
the bone. If reconstruction screws are
planned, the C-arm must allow for lateral
imaging of the femoral head and neck.
Adduction of the injured femur can also
be helpful when placing reconstruction
screws.
Drape the patient appropriately to allow
the surgeon to work from the hip to the
knee.
Reduction
It is critical to achieve anatomic
reduction before beginning any of the
steps to place the IM Nail. Traction
should be used as necessary to help
achieve fracture reduction. Several
instruments are available to assist in
fracture reduction including clamps,
reduction tongs, ball spike pushers and
Steinman pins.
Certain portions of the surgical
procedure differ depending on whether
a surgeon chooses to use a Greater
Trochanter Entry Point Nail or a Piriformis
Fossa Entry Point Nail. Please follow the
appropriate portion of the technique
that directs use of the chosen nail type.
Most pictures depict use of the Greater
Trochanteric Entry Point. Do not attempt
to use the Greater Trochanter Entry Point
Nail through a Piriformis Fossa Entry
Point or vice versa.
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
4
Greater Trochanter Entry Point
Starting Point Location
The starting point for the nail is located on the tip of the greater
trochanter (Figure 1). On the AP image, the starting point
should be on the tip of the greater trochanter, not lateral. On
the lateral image, the starting point should be in the midpoint
of the greater trochanter. For a proximal femur fracture where
recon screws will be used, the entry point on the lateral image is
at the junction of the anterior 1/3 and the posterior 2/3 of the
greater trochanter.
Begin the skin incision 3cm proximal to the greater trochanter.
A larger incision may be desired for obese patients. Split the
fascia of the gluteus maximus in line with its fibers. Identify
the subfascial plane of the gluteus medius, and palpate the
posterior tip of the greater trochanter. A 3.0mm threaded pin
can also be used to create a stab incision and advanced down
to the greater trochanter (Figure 2). The ENTRY CANNULA
STARTING POINT LOCATOR placed inside the ENTRY CANNULA
can also assist with dissection down to the bone (Figure 3).
Fig. 1
Fig. 2
Fig. 3
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 5
Piriformis Fossa Entry Point
Starting Point Location
The starting point for the nail is located in the piriformis fossa
for a standard shaft fracture (Figure 1). For a proximal femur
fracture where recon screws will be used, the entry point is 5mm
anterior to the normal piriformis entry point. Begin the skin
incision 3cm proximal to the greater trochanter. A larger incision
may be desired for obese patients. Split the fascia of the gluteus
maximus in line with its fibers. Identify the subfascial plane of
the gluteus medius, and palpate the posterior tip of the greater
trochanter. A 3.0mm threaded pin can also be used to create a
stab incision and gain entry into the fossa (figure 2). The ENTRY
CANNULA STARTING POINT LOCATOR placed inside the ENTRY
CANNULA can also assist with dissection down to the bone
(Figure3).
Fig. 1
Fig. 2
Fig. 3
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
6
Place the 3.0mm threaded pin into the
starting point. Use the C-arm to visualize
the pin’s position from A/P and Lateral
views. The pin should be inserted at the
identified point in the direction of the
center of the medullary canal.
Drive the pin through the starting point into
the center of the medullary canal. Use the
8.0mm ENTRY REAMER to ream an entry
portal into the proximal femur through
the starting point (Figure 4). Remove the
reamer and 3.0mm pin.
Alternatively, an AWL can be used to find
the entry point and create the entry portal.
Place a 3.0mm x 100cm BALL TIP GUIDE
WIRE (00/47-2255-008-01) into the
medullary canal all the way into the distal
femur (Figure 5). To aid in manipulation,
bend the tip of the guide wire at about a
10 degree angle 5cm from the end.
CAUTION: If the guide wire is bent shorter
than 5cm from the end of the wire and/or
more than 10 degrees it may be difficult to
remove from the nail. If the wire becomes
lodged inside the nail, utilize the GUIDE
WIRE GRIPPER and mallet to remove the
guide wire from the nail.
Fluoroscopy can assist you in guiding the
wire past the fracture site. If you plan to
ream the canal of the femur, the ball tip
wire should be centered and embedded
in the distal femur at the level of the
distal epiphyseal scar using the GUIDE
WIRE GRIPPER and a MALLET (Figure 6).
Care should be taken not to drive the wire
through the distal femur.
A REDUCTION FINGER is included in the
set. The ball tip guide wire can be fed
retrograde through the REDUCTION FINGER.
The REDUCTION FINGER can then be placed
into the femur and used to help reduce the
femur from the inside as well as to help
facilitate passage of the guide wire past the
fracture site.
Assemble the two piece NAIL LENGTH
GAUGE. Slide the tube portion of the
gauge over the 3.0mm x 100cm ball tip
guide wire until the tip of the tube is
at the level of the entry point (confirm
position using fluoroscopy) (Figure 7).
The proximal end of the ball tip guide
wire indicates the length of the wire in
the canal. When determining nail length,
consideration should be taken as to how
deep the nail will be inserted into the
femur based upon the desired location
of the proximal screws. A RULER is also
included in the set which can be used to
radiographically determine nail length.
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 7
Proximal Reaming
Use the 14.5mm TAPERED REAMER
to prepare the proximal femur for the
proximal portion of the nail (Figure 8).
The C-arm should be used to visualize
the depth of the reamer in the proximal
femur. Care should be taken to keep the
reamer in line with the shaft of the femur
to avoid reaming through the cortex of
the femur.
The 14.5mm TAPERED REAMER has three
grooves on it. The most proximal groove
indicates the final position of the top
of the nail. The two distal grooves help
visualize the placement of the recon
screws. Visualizing a line between these
grooves on each side of the reamer
(under fluoroscopy) will indicate the
approximate centerline between the
recon screws to help facilitate placement
in the femoral neck and head.
8.3mm Greater Trochanter Entry Point
Nail Note: The 8.3mm nail has a proximal
diameter of 12.0mm. With this size nail,
a shaft reamer should be used, instead
of the 14.5mm TAPERED or CHANNEL
REAMER, to create an opening 13.0 to
13.5mm in diameter proximally. This will
allow the head of the nail to be safely
inserted into the bone, without removing
an excess amount of bone.
A CHANNEL REAMER is also available for
proximal reaming. The INNER CHANNEL
REAMER is placed inside the 14.5mm
CHANNEL REAMER SLEEVE and secured
by twisting the connector. The CHANNEL
REAMER is then advanced over the guide
wire through the piriformis fossa/greater
trochanter. Advance the reamer to level
of the lesser trochanter (Figure 9) or deep
enough to accommodate the proximal
body of the nail. Care should be taken to
keep the reamer in line with the shaft of
the femur to avoid reaming through the
cortex of the femur.
After reaming to the proper depth to
accommodate the proximal body of the
nail, the INNER CHANNEL REAMER is
removed by disengaging the connector
and pulling the INNER CHANNEL REAMER
out of the surgical field (Figure 10). The
CHANNEL REAMER SLEEVE can be left in
place to act as a tissue protection sleeve
during shaft reaming for shaft reamers
up to 13mm in diameter. To achieve
greater reaming depth or diameter, the
ENTRY CANNULA can be used in place of
the sleeve. To facilitate reamer removal
Fig. 8
Fig. 9
Fig. 10
Fig. 11
via the sleeve, power the reamer until
it enters the sleeve. Following shaft
reaming the CHANNEL REAMER SLEEVE
should be removed from the surgical
field (Figure 11).
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
8
Shaft Reaming
Start with a small Zimmer® Pressure
Sentinel® Reamer. Increase the diameter
of the reamer by 0.5 - 1.0mm depending
on the amount of resistance felt while
reaming (Figure 13). The GUIDE WIRE
PUSHER can help prevent the ball tip
guide wire from coming out of the femur
during reaming. When cortical chatter
occurs, stop reaming. Choose a nail
that is 1.0 – 1.5mm smaller than the last
reamer used. The proximal diameter of
nails smaller than 13mm is 13mm. For
nails 13mm and larger in diameter, the
diameter of the nail is constant.
NOTE: If the Guide Wire becomes lodged
within the reamer, use the Guide Wire
Pusher to push the Guide Wire back into
the IM canal.
Nail Assembly and Insertion
The color code for the antegrade femur
nails is GREEN. Ti-6Al-4V alloy nails, the
TARGETING GUIDE and the CONNECTING
BOLT all have GREEN colors on them, as
well as the word GREEN etched on them.
Place the CONNECTING BOLT through the
barrel of the TARGETING GUIDE HANDLE
(Figure 14). Rotate the nail around the
CONNECTING BOLT to begin threading
the bolt into the proximal portion of the
nail. Completely tighten the CONNECTING
BOLT to secure the nail to the guide. The
arrow on the barrel of the TARGETING
GUIDE HANDLE will line up with the arrow
and appropriate letter on nail (R for Right
Femur, L for Left Femur) when the nail is
correctly aligned. Ensure that the nail is
tightened to the barrel of the guide and
that the teeth on the barrel interdigitate
with the notches in the nail (Figure 15).
Use a screw cannula, drill sleeve and
drill bit to verify that the holes in the
guide target the holes in the nail. If
using descending interlocking or
reconstruction screws, the appropriate
TARGETING MODULE should be attached
to verify that the drills line up with the
holes in the nail. Thread the connecting
knob into the module before attaching
the module to the guide.
Fig. 13
Fig. 14
Fig. 15
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 9
Note: Remove the TARGETING MODULE before inserting the
nail.
Greater Trochanter Entry Point Nail Insertion
Insert the nail over the guide wire with the arm of the guide
facing anterior to the patient (Figure 16GT). The guide will turn
90° as it passes down the femoral canal. The combination of
the nail’s anatomic shape as well as the flutes in the nail will
help the nail rotate as it passes down the canal. Monitor the
progression of the nail using the C-arm, especially as the nail
is passing through or near the fracture site.
Piriformis Fossa Entry Point Nail Insertion
Fig. 16GT Fig. 16PF
CAUTION: Do not pry excessively on the targeting guide as damage may result.
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
10
Insert the nail over the guide wire with
the arm of the
guide facing lateral to the patient (Figure
16PF). Monitor
the progression of the nail down the
canal using the
C-arm, especially as the nail is passing
through or near
the fracture site.
If the nail does not pass down the canal
easily, attach the IMPACTION HEAD to
the TARGETING GUIDE HANDLE. Using the
MALLET, impact gently on the IMPACTION
HEAD (Figure 17). Do not strike the guide.
CAUTION: Do not strike excessively as
damage to the targeting guide and bone
may result.
Verify that the CONNECTING BOLT is tight
while impacting. Do not impact on any
other portion of the TARGETING GUIDE
HANDLE or MODULE as this may break
the guide or cause it to lose its accuracy.
If the nail will not advance with
impaction, remove the nail and ream the
canal to a larger diameter at additional
0.5 mm increments or consider using a
smaller diameter nail. Place the top of
the nail in line with or below the surface
of the entry point, depending on its
position relative to the expected screw
location.
Fig. 17 Fig. 18
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 11
Recon Module Interlocking Module
Remove the ball tip guide wire from
the nail using the GUIDE WIRE GRIPPER
(Figure 18). If possible, the guide wire
should be removed before the nail
is completely seated to reduce the
potential for the wire to get caught in
the nail. If the wire is difficult to remove,
rotate the wire 90o with the GUIDE WIRE
GRIPPER while pulling the wire.
Proximal Screw Placement
Proximal Screw Diameter:
6.0mm for Reconstruction or Descending
Interlocking Screws, 5.0mm for
Transverse Interlocking Screws
Proximal Screw Lengths:
6.0mm – 50 to 140mm in 5mm
increments
5.0mm - 20 to 60mm in 2.5mm
increments, 65 to 100mm in 5mm
increments
Distal Screw Diameter:
5.0mm for 9.3 to 15mm nails, 4.0mm for
8.3mm nails (Greater Troch Nail Only)
Distal Screw Lengths:
20 to 60mm in 2.5mm increments, 65 to
100mm in 5mm increments
The reconstruction screw holes in
the nail should be used with partially
threaded 6.0mm screws. The descending
interlock holes should be used with
fixed angle 6.0mm screws although this
will not create a fixed angle construct.
The transverse interlocking holes use
5.0mm screws. A fixed angle construct
can be created by using 5.0mm fixed
angle screws in these holes. If a fixed
angle construct is not desired*, partially
threaded 5.0mm screws should be used
in the transverse interlocking holes.
The instruments needed to place screws
through the proximal portion of the nail
are color coded according to the chart.
INSTRUMENT TYPE SMALL
Large Diameter Screw Cannula (recon/interlock screws) Orange
Small Diameter Screw Cannula (transverse screws) Orange
Trocar Orange
4.3mm Drill Sleeve (5.0mm screws) Orange / Red
4.3mm Drill Bit (5.0mm screws) Orange / Red
4.9mm Drill Sleeve 6.0mm screws) Orange / Black
4.9mm Drill Bit (6.0mm screws ) Orange / Black
3.0mm Pin Sleeve Orange
Depth Gauge Orange
Screwdriver Orange
Note: 4.0 screws contain the color/
color name WHITE on the label and
corresponding screw case. 5.0mm
screws contain the color/color name
of RED on the label and corresponding
screw case. 6.0mm screws contain the
color/color name of BLACK on the label
and screw case. These colors match
the color rings on the drills and other
relevant instruments.
CAUTION: Retighten the CONNECTING
BOLT to the nail to maintain targeting
accuracy. If modules inadvertantly
left on during impaction, retighten
CONNECTINGS KNOBS to maintain
targeting accuracy.
If using the descending interlocking
or reconstruction screws, attach the
appropriate TARGETING MODULE to the
TARGETING GUIDE HANDLE. Select the
screw holes that will be used in the nail.
Insert HOLE INDICATORS in the holes
in the TARGETING GUIDE HANDLE and
TARGETING MODULE that WILL NOT be
used.
* Under certain conditions, especially in patients with thin cortical bone, Partially Threaded Screws from 20mm to 32.5mm in length may form a Fixed Angle construct with the nail.
The following proximal screw combinations are NOT
possible because the screws may run into one another.
Distal Recon Screw and
Distal Descending Oblique -
6.0mm Screws
Proximal Recon Screw and
Proximal Descending Oblique -
6.0mm Screws
Distal Descending Oblique
6.0mm and 5.0mm Static
Transverse Screw
Distal 6.0mm Recon
Screw and 5.0mm Static
Transverse Screw
Static Transverse and
Proximal Dynamization -
5.0mm Screws
Note: The proximal pattern on the
8.3mm nail differs from the larger
diameter nails. See page 19 for details.
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
12
Slide the TROCAR into the SCREW
CANNULA (Figure 19). Slide the SCREW
CANNULA through one of the selected
holes in the TARGETING GUIDE or
MODULE. Incise the skin at the point the
TROCAR touches it and dissect through
the tissue down to the bone to make a
path for the SCREW CANNULA. Advance
the SCREW CANNULA until the tip of the
TROCAR is against the bone (Figure 20).
CAUTION: Do not impact on the cannula.
Remove the TROCAR. Insert the
appropriate sized DRILL SLEEVE through
the CANNULA down to the bone. Place
the appropriate sized DRILL BIT through
the DRILL SLEEVE (Figure 21). Before
the DRILL BIT contacts the bone, start
the drill. Advance the spinning DRILL
BIT through the bone bicortically. Use
fluoroscopy to verify the appropriate
location of the DRILL BIT in the bone.
(Note: if reconstruction screws are used,
do not advance the DRILL BIT through the
second cortex of the bone. Only advance
it as far as is necessary to obtain proper
fixation.)
CAUTION: In cases where hard cortical
bone is encountered or at the surgeon’s
preference, a 5.0mm TAP can be used to
ease insertion of the screws.
Fig. 19
Fig. 20
Fig. 21
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 13
Fig. 25
With the DRILL BIT in place and the DRILL
SLEEVE pressed against the bone, the
length of screw needed is indicated by
the etch marks on the DRILL BIT where
it exits the DRILL SLEEVE (Figure 22).
The tip of the drill should be no more
than 5mm through the far cortex of the
bone to reduce the risk of complications
associated with screw protrusion.
(Alternatively, the DRILL BIT and DRILL
SLEEVE can be removed and the SCREW
DEPTH GAUGE used to measure the
length of screw.)
Remove the DRILL BIT and DRILL
SLEEVE. Place the appropriate length
and diameter screw through the SCREW
CANNULA into the bone (Figure 23).
Use the 3.5mm HEX SCREWDRIVER to
advance the screw to achieve bicortical
purchase (Figure 24) (the screw head
should sit on the near cortex of the bone)
(Figure 25). The screws are self tapping
so tapping should not be necessary.
If using the CAPTURED SCREWDRIVER,
place the appropriate screw on the
3.5mm HEX and tighten the screw to the
CAPTURED SCREWDRIVER by turning the
knob next to the handle clockwise.
CAUTION: When using any screwdriver,
do not torque it beyond the calibration
line next to the handle. Do not drive the
screws into the bone under power, as
damage to the bone, screws or nail could
result.
Repeat this technique to place additional
proximal screws as necessary.
Fig. 22
Fig. 23
Fig. 24
Note: If placing both transverse screws,
place the static screw first. When
placing the dynamic screw, advance the
cannula to the top of the static screw
head. Do not advance the cannula to the
bone.
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
14
Distal Targeting – Freehand
Technique
All nails 9.3mm in diameter and larger
use a 5.0mm screw (4.3mm drill bit)
distally. The 8.3mm Greater Trochanter
Entry Point Nail uses a 4.0mm screw
(3.3mm drill bit) distally. Use the 3.3mm
(color coded WHITE) drill bit and 4.0mm
(color coded WHITE) screws when using
the 8.3mm Greater Troch Nail in place of
the 4.3mm bit and 5.0mm screws listed
below.
Insert the 4.3mm FREE HAND DRILL BIT
(color coded RED) into the FREE HAND
TARGETING WAND. Finger tighten the
SET SCREW. Position the C-arm in order
to get a lateral view of the distal femur.
Adjust the position of the C-arm so that
the hole through the nail appears as a
perfect circle on the monitor. Bring the
tip of the drill bit to the skin and use the
C-arm to center it over the hole that you
desire to place a screw through. Make
a stab incision at this point and dissect
down to the bone. Place the tip of the
drill bit against the bone (Figure 26).
Verify that the tip of the drill bit is in the
center of the hole. Align the drill bit with
the C-arm beam. Tap the drill bit into the
bone using the MALLET.
Loosen the SET SCREW and remove the
FREE HAND TARGETING WAND, leaving
the DRILL BIT in place. Slide the FREE
HAND TISSUE PROTECTION SLEEVE over
the DRILL BIT (Figure 27). Attach the
DRILL to the DRILL BIT and advance the
drill bit through the bone. Verify that the
drill bit has gone through the hole in the
nail.
Fig. 26
Fig. 27
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 15
Remove the drill bit. Measure the depth
of the hole using the FREE HAND SCREW
DEPTH GAUGE (Figure 28). (Alternatively,
the appropriate length of screw can be
measured using the numbered etch on
the DRILL BIT closest to the end of the
FREE HAND TISSUE PROTECTION SLEEVE
when the DRILL BIT is in the bone and
the SLEEVE is touching the bone.) Insert
the appropriate length screw using the
3.5mm HEX SCREWDRIVER (Figure 29).
If using the CAPTURED SCREWDRIVER,
place the appropriate screw on the
3.5mm HEX and tighten the screw to the
CAPTURED SCREWDRIVER by turning the
knob next to the handle clockwise.
CAUTION: If using the CAPTURED
SCREWDRIVER, do not torque the
CAPTURED SCREWDRIVER beyond the
calibration line next to the handle. Do
not drive the screws into the bone under
power, as damage to the bone, screws
and nail could result.
Repeat these steps to insert additional
distal screws.
Fig. 29
Fig. 28
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
16
Finalize Implant Placement
Observe the depth of the nail in the
proximal femur. Ridges in the targeting
guide barrel indicate 5 and 10mm of
depth. A 3.0mm pin can be placed
through the hole in the guide to
approximate the position of the top of
the nail.
Disconnect any TARGETING MODULES
from the TARGETING GUIDE HANDLE and
set aside. Place a 2.0MM GUIDE PIN
through the CONNECTING BOLT down to
the level of the proximal screws. Loosen
and remove the CONNECTING BOLT from
the nail. Remove the TARGETING GUIDE
HANDLE and set aside.
Choose the appropriate height
cannulated NAIL CAP. Secure the
selected NAIL CAP to the NAIL CAP
INSERTER using the NAIL CAP RETAINING
SHAFT. Slide the cannulated NAIL CAP
over the 2.0MM GUIDE PIN and tighten
to the nail. Using the C-arm, verify that
the cap is completely seated to the top
of the nail.
Disengage the NAIL CAP INSERTER from
the NAIL CAP. Remove the 2.0MM GUIDE
PIN.
Close all wounds and apply the
appropriate dressings.
If a module was used, remove the
connecting knob from the module before
cleaning and sterilization.
Postoperative Care
Early range of motion exercises of the
hip and knee are encouraged. Allow
toe-touch weight bearing to progress
to full weight bearing as fracture callus
increases on the x-ray films.*
Nail Extraction
Use the C-arm to locate any distal
screws. Remove the distal screws using
a 3.5mm HEX SCREWDRIVER. Remove
the nail cap (if one was inserted) with a
5.0mm HEX SCREWDRIVER. Expose the
proximal screws and use a 3.5mm HEX
SCREWDRIVER to remove them. If bone
has grown into any of the screws, nail
cap or nail that would inhibit implant
removal, use instruments such as
rongeurs, dental picks or drills to remove
bone in-growth before attempting
implant removal. Take care not to
damage the implant itself while removing
ingrown bone.
To remove the nail, slide a 2.0MM GUIDE
PIN into the top of the nail. Insert the
CANNULATED EXTRACTION ADAPTER over
the wire into the top of the nail (Figure
30). Tighten the adapter to the nail using
a PIN WRENCH. Attach a slaphammer
or other impaction device and impact to
back out the nail (Figure 31).
Greater Trochanter Entry Point Nail Note:
The nail will rotate approximately 90° as
it is removed from the femur.
Fig. 30
Fig. 31
* It is the responsibility of the surgeon to determine what is the most suitable postoperative care depending on each patient’s health condition.
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 17
Antegrade Femoral PF Nail Details
Anterior bevel on tip
45 to 50mm from tip
80mm
proximal
body length
1270mm
Anterior Bow Radius
Lengths 24 through 34cm
1400mm
Anterior Bow Radius
Lengths 36 through 42cm
1520mm
Anterior Bow Radius
Lengths 44 through 48cm
9.3, 10, 11, 12, 13, 14,
15mm Shaft Diameters
13mm Head (Up to 13mm shaft)
30 to 63mm from top - recon/interlock screws
(large-diameter cannula)
47 to 53mm from top - recon/interlock screws
(large-diameter cannula)
Dynamic Slot 66 to 78mm from top
58 to 63mm from top - transverse screws
(small-diameter cannula)
Straight Flutes
34 to 39mm from tip
Dynamic Slot 17 to 29mm from tip
7 to 12mm from tip
6.0mm Screw
8mm Diameter Head
3.4mm Head Height
4.8mm Minor Diameter
4.9mm Drill
2.8mm Tip Length
5.0mm Screw
8mm Diameter Head
3.9mm Head Height
4.3mm Minor Diameter
4.3mm Drill
2.2mm Tip Length
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
18
30 to 63mm from top - recon/interlock screws
(large-diameter cannula)
47 to 53mm from top - recon/interlock screws
(large-diameter cannula)
58 to 63mm from top - transverse screws
(small-diameter cannula)
Antegrade Femoral GT Nail Details
(9.3mm and greater)
13mm Head (Up to 13mm shaft)
Dynamic Slot 66 to 78mm from top
80mm
proximal
body length
1270mm
Anterior Bow Radius
Lengths 24 through 34cm
1400mm
Anterior Bow Radius
Lengths 36 through 42cm
1520mm
Anterior Bow Radius
Lengths 44 through 48cm
9.3, 10, 11, 12, 13,
14mm Shaft Diameters
Spiral Flutes
Anterior bevel on tip
45 to 50mm from tip
34 to 39mm from tip
Dynamic Slot 17 to 29mm from tip
7 to 12mm from tip
3.1° Proximal Lateralization Angle
6.0mm Screw
8mm Diameter Head
3.4mm Head Height
4.8mm Minor Diameter
4.9mm Drill
2.8mm Tip Length
5.0mm Screw
8mm Diameter Head
3.9mm Head Height
4.3mm Minor Diameter
4.3mm Drill
2.2mm Tip Length
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 19
12mm Head
30 to 36mm from top - recon screws (large-diameter cannula)
47 to 53mm from top - recon screws (large-diameter cannula)
73mm
proximal
body length
1270mm
Anterior Bow Radius
Lengths 24 – 34cm
1400mm
Anterior Bow Radius
Lengths 36 – 40cm
8.3mm Shaft Diameter
Spiral Flutes
17.5 to 21.5mm from tip
7.5 to 11.5mm from tip
6.0mm Screw
8mm Diameter Head
3.4mm Head Height
4.8mm Minor Diameter
4.9mm Drill
2.8mm Tip Length
5.0mm Screw
8mm Diameter Head
3.9mm Head Height
4.3mm Minor Diameter
4.3mm Drill
2.2mm Tip Length
4.0mm Screw
7mm Diameter Head
3.9mm Head Height
3.4mm Minor Diameter
3.3mm Drill
1.8mm Tip Length
Antegrade Femoral GT 8.3mm Nail Details
66 to 71mm from top -
transverse screws
(small-diameter
cannula; use hole
marked “DY 9.3+/
ST 8.3” on guide)
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
20
Pre-Op Post-Op
Post-Op
Case Examples
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 21
Item Number Product Description
47-2492-260-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 26cm Right Ti-6Al-4V
47-2492-280-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 28cm Right Ti-6Al-4V
47-2492-300-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 30cm Right Ti-6Al-4V
47-2492-320-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 32cm Right Ti-6Al-4V
47-2492-340-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 34cm Right Ti-6Al-4V
47-2492-360-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 36cm Right Ti-6Al-4V
47-2492-380-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 38cm Right Ti-6Al-4V
47-2492-400-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 40cm Right Ti-6Al-4V
47-2492-260-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 26cm Right Ti-6Al-4V
47-2492-280-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 28cm Right Ti-6Al-4V
47-2492-300-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 30cm Right Ti-6Al-4V
47-2492-320-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 32cm Right Ti-6Al-4V
47-2492-340-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 34cm Right Ti-6Al-4V
47-2492-360-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 36cm Right Ti-6Al-4V
47-2492-380-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 38cm Right Ti-6Al-4V
47-2492-400-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 40cm Right Ti-6Al-4V
47-2492-420-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 42cm Right Ti-6Al-4V
47-2492-440-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 44cm Right Ti-6Al-4V
47-2492-460-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 46cm Right Ti-6Al-4V
47-2492-260-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 26cm Right Ti-6Al-4V
47-2492-280-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 28cm Right Ti-6Al-4V
47-2492-300-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 30cm Right Ti-6Al-4V
47-2492-320-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 32cm Right Ti-6Al-4V
47-2492-340-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 34cm Right Ti-6Al-4V
47-2492-360-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 36cm Right Ti-6Al-4V
47-2492-380-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 38cm Right Ti-6Al-4V
47-2492-400-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 40cm Right Ti-6Al-4V
47-2492-420-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 42cm Right Ti-6Al-4V
47-2492-440-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 44cm Right Ti-6Al-4V
47-2492-460-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 46cm Right Ti-6Al-4V
47-2492-260-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 26cm Right Ti-6Al-4V
47-2492-280-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 28cm Right Ti-6Al-4V
47-2492-300-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 30cm Right Ti-6Al-4V
47-2492-320-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 32cm Right Ti-6Al-4V
47-2492-340-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 34cm Right Ti-6Al-4V
47-2492-360-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 36cm Right Ti-6Al-4V
47-2492-380-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 38cm Right Ti-6Al-4V
47-2492-400-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 40cm Right Ti-6Al-4V
47-2492-420-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 42cm Right Ti-6Al-4V
47-2492-440-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 44cm Right Ti-6Al-4V
47-2492-460-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 46cm Right Ti-6Al-4V
47-2492-260-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 26cm Right Ti-6Al-4V
47-2492-280-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 28cm Right Ti-6Al-4V
47-2492-300-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 30cm Right Ti-6Al-4V
47-2492-320-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 32cm Right Ti-6Al-4V
47-2492-340-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 34cm Right Ti-6Al-4V
47-2492-360-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 36cm Right Ti-6Al-4V
47-2492-380-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 38cm Right Ti-6Al-4V
47-2492-400-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 40cm Right Ti-6Al-4V
47-2492-420-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 42cm Right Ti-6Al-4V
Product Information
Antegrade Femur, Greater Trochanter Nails
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
22
47-2492-440-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 44cm Right Ti-6Al-4V
47-2492-460-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 46cm Right Ti-6Al-4V
47-2492-260-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 26cm Right Ti-6Al-4V
47-2492-280-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 28cm Right Ti-6Al-4V
47-2492-300-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 30cm Right Ti-6Al-4V
47-2492-320-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 32cm Right Ti-6Al-4V
47-2492-340-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 34cm Right Ti-6Al-4V
47-2492-360-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 36cm Right Ti-6Al-4V
47-2492-380-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 38cm Right Ti-6Al-4V
47-2492-400-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 40 cm Right Ti-AL-4V
47-2492-420-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 42cm Right Ti-6Al-4V
47-2492-440-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 44cm Right Ti-6Al-4V
47-2492-460-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 46cm Right Ti-6Al-4V
47-2492-480-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 48cm Right Ti-6Al-4V
47-2492-260-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 26cm Right Ti-6Al-4V
47-2492-280-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 28cm Right Ti-6Al-4V
47-2492-300-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 30cm Right Ti-6Al-4V
47-2492-320-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 32cm Right Ti-6Al-4V
47-2492-340-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 34cm Right Ti-6Al-4V
47-2492-360-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 36cm Right Ti-6Al-4V
47-2492-380-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 38cm Right Ti-6Al-4V
47-2492-400-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 40cm Right Ti-6Al-4V
47-2492-420-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 42cm Right Ti-6Al-4V
47-2492-440-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 44cm Right Ti-6Al-4V
47-2492-460-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 46cm Right Ti-6Al-4V
47-2492-261-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 26cm Left Ti-6Al-4V
47-2492-281-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 28cm Left Ti-6Al-4V
47-2492-301-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 30cm Left Ti-6Al-4V
47-2492-321-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 32cm Left Ti-6Al-4V
47-2492-341-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 34cm Left Ti-6Al-4V
47-2492-361-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 36cm Left Ti-6Al-4V
47-2492-381-08 Antegrade GREATER TROCHANTER Femoral Nail
8.3mm X 38cm Left Ti-6Al-4V
47-2492-401-08 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 40cm Left Ti-6Al-4V
47-2492-261-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 26cm Left Ti-6Al-4V
47-2492-281-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 28cm Left Ti-6Al-4V
47-2492-301-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 30cm Left Ti-6Al-4V
47-2492-321-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 32cm Left Ti-6Al-4V
47-2492-341-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 34cm Left Ti-6Al-4V
47-2492-361-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 36cm Left Ti-6Al-4V
47-2492-381-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 38cm Left Ti-6Al-4V
47-2492-401-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 40cm Left Ti-6Al-4V
47-2492-421-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 42cm Left Ti-6Al-4V
47-2492-441-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 44cm Left Ti-6Al-4V
47-2492-461-09 Antegrade GREATER TROCHANTER Femoral Nail
9.3mm X 46cm Left Ti-6Al-4V
47-2492-261-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 26cm Left Ti-6Al-4V
47-2492-281-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 28cm Left Ti-6Al-4V
47-2492-301-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 30cm Left Ti-6Al-4V
47-2492-321-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 32cm Left Ti-6Al-4V
47-2492-341-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 34cm Left Ti-6Al-4V
47-2492-361-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 36cm Left Ti-6Al-4V
47-2492-381-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 38cm Left Ti-6Al-4V
47-2492-401-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 40cm Left Ti-6Al-4V
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 23
47-2492-421-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 42cm Left Ti-6Al-4V
47-2492-441-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 44cm Left Ti-6Al-4V
47-2492-461-10 Antegrade GREATER TROCHANTER Femoral Nail
10mm X 46cm Left Ti-6Al-4V
47-2492-261-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 26cm Left Ti-6Al-4V
47-2492-281-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 28cm Left Ti-6Al-4V
47-2492-301-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 30cm Left Ti-6Al-4V
47-2492-321-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 32cm Left Ti-6Al-4V
47-2492-341-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 34cm Left Ti-6Al-4V
47-2492-361-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 36cm Left Ti-6Al-4V
47-2492-381-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 38cm Left Ti-6Al-4V
47-2492-401-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 40cm Left Ti-6Al-4V
47-2492-421-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 42cm Left Ti-6Al-4V
47-2492-441-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 44cm Left Ti-6Al-4V
47-2492-461-11 Antegrade GREATER TROCHANTER Femoral Nail
11mm X 46cm Left Ti-6Al-4V
47-2492-261-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 26cm Left Ti-6Al-4V
47-2492-281-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 28cm Left Ti-6Al-4V
47-2492-301-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 30cm Left Ti-6Al-4V
47-2492-321-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 32cm Left Ti-6Al-4V
47-2492-341-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 34cm Left Ti-6Al-4V
47-2492-361-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 36cm Left Ti-6Al-4V
47-2492-381-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 38cm Left Ti-6Al-4V
47-2492-401-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 40cm Left Ti-6Al-4V
47-2492-421-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 42cm Left Ti-6Al-4V
47-2492-441-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 44cm Left Ti-6Al-4V
47-2492-461-12 Antegrade GREATER TROCHANTER Femoral Nail
12mm X 46cm Left Ti-6Al-4V
47-2492-261-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 26cm Left Ti-6Al-4V
47-2492-281-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 28cm Left Ti-6Al-4V
47-2492-301-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 30cm Left Ti-6Al-4V
47-2492-321-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 32cm Left Ti-6Al-4V
47-2492-341-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 34cm Left Ti-6Al-4V
47-2492-361-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 36cm Left Ti-6Al-4V
47-2492-381-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 38cm Left Ti-6Al-4V
47-2492-401-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 40cm Left Ti-6Al-4V
47-2492-421-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 42cm Left Ti-6Al-4V
47-2492-441-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 44cm Left Ti-6Al-4V
47-2492-461-13 Antegrade GREATER TROCHANTER Femoral Nail
13mm X 46cm Left Ti-6Al-4V
47-2492-261-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 26cm Left Ti-6Al-4V
47-2492-281-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 28cm Left Ti-6Al-4V
47-2492-301-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 30cm Left Ti-6Al-4V
47-2492-321-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 32cm Left Ti-6Al-4V
47-2492-341-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 34cm Left Ti-6Al-4V
47-2492-361-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 36cm Left Ti-6Al-4V
47-2492-381-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 38cm Left Ti-6Al-4V
47-2492-401-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 40cm Left Ti-6Al-4V
47-2492-421-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 42cm Left Ti-6Al-4V
47-2492-441-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 44cm Left Ti-6Al-4V
47-2492-461-14 Antegrade GREATER TROCHANTER Femoral Nail
14mm X 46cm Left Ti-6Al-4V
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
24
47-2491-300-09 Antegrade Femur Piriformis Fossa Nail 9.3mm X
30cm Univ Ti-6Al-4V
47-2491-320-09 Antegrade Femur Piriformis Fossa Nail 9.3mm X
32cm Univ Ti-6Al-4V
47-2491-340-09 Antegrade Femur Piriformis Fossa Nail 9.3mm X
34cm Univ Ti-6Al-4V
47-2491-360-09 Antegrade Femur Piriformis Fossa Nail 9.3mm X
36cm Univ Ti-6Al-4V
47-2491-380-09 Antegrade Femur Piriformis Fossa Nail 9.3mm X
38cm Univ Ti-6Al-4V
47-2491-400-09 Antegrade Femur Piriformis Fossa Nail 9.3mm X
40cm Univ Ti-6Al-4V
47-2491-420-09 Antegrade Femur Piriformis Fossa Nail 9.3mm X
42cm Univ Ti-6Al-4V
47-2491-440-09 Antegrade Femur Piriformis Fossa Nail 9.3mm X
44cm Univ Ti-6Al-4V
47-2491-460-09 Antegrade Femur Piriformis Fossa Nail 9.3mm X
46cm Univ Ti-6Al-4V
47-2491-300-10 Antegrade Femur Piriformis Fossa Nail 10mm X
30cm Univ Ti-6Al-4V
47-2491-320-10 Antegrade Femur Piriformis Fossa Nail 10mm X
32cm Univ Ti-6Al-4V
47-2491-340-10 Antegrade Femur Piriformis Fossa Nail 10mm X
34cm Univ Ti-6Al-4V
47-2491-360-10 Antegrade Femur Piriformis Fossa Nail 10mm X
36cm Univ Ti-6Al-4V
47-2491-380-10 Antegrade Femur Piriformis Fossa Nail 10mm X
38cm Univ Ti-6Al-4V
47-2491-400-10 Antegrade Femur Piriformis Fossa Nail 10mm X
40cm Univ Ti-6Al-4V
47-2491-420-10 Antegrade Femur Piriformis Fossa Nail 10mm X
42cm Univ Ti-6Al-4V
47-2491-440-10 Antegrade Femur Piriformis Fossa Nail 10mm X
44cm Univ Ti-6Al-4V
47-2491-460-10 Antegrade Femur Piriformis Fossa Nail 10mm X
46cm Univ Ti-6Al-4V
47-2491-300-11 Antegrade Femur Piriformis Fossa Nail 11mm X
30cm Univ Ti-6Al-4V
47-2491-320-11 Antegrade Femur Piriformis Fossa Nail 11mm X
32cm Univ Ti-6Al-4V
47-2491-340-11 Antegrade Femur Piriformis Fossa Nail 11mm X
34cm Univ Ti-6Al-4V
47-2491-360-11 Antegrade Femur Piriformis Fossa Nail 11mm X
36cm Univ Ti-6Al-4V
47-2491-380-11 Antegrade Femur Piriformis Fossa Nail 11mm X
38cm Univ Ti-6Al-4V
47-2491-400-11 Antegrade Femur Piriformis Fossa Nail 11mm X
40cm Univ Ti-6Al-4V
47-2491-420-11 Antegrade Femur Piriformis Fossa Nail 11mm X
42cm Univ Ti-6Al-4V
47-2491-440-11 Antegrade Femur Piriformis Fossa Nail 11mm X
44cm Univ Ti-6Al-4V
47-2491-460-11 Antegrade Femur Piriformis Fossa Nail 11mm X
46cm Univ Ti-6Al-4V
47-2491-300-12 Antegrade Femur Piriformis Fossa Nail 12mm X
30cm Univ Ti-6Al-4V
47-2491-320-12 Antegrade Femur Piriformis Fossa Nail 12mm X
32cm Univ Ti-6Al-4V
47-2491-340-12 Antegrade Femur Piriformis Fossa Nail 12mm X
34cm Univ Ti-6Al-4V
47-2491-360-12 Antegrade Femur Piriformis Fossa Nail 12mm X
36cm Univ Ti-6Al-4V
47-2491-380-12 Antegrade Femur Piriformis Fossa Nail 12mm X
38cm Univ Ti-6Al-4V
47-2491-400-12 Antegrade Femur Piriformis Fossa Nail 12mm X
40cm Univ Ti-6Al-4V
47-2491-420-12 Antegrade Femur Piriformis Fossa Nail 12mm X
42cm Univ Ti-6Al-4V
47-2491-440-12 Antegrade Femur Piriformis Fossa Nail 12mm X
44cm Univ Ti-6Al-4V
47-2491-460-12 Antegrade Femur Piriformis Fossa Nail 12mm X
46cm Univ Ti-6Al-4V
47-2491-300-13 Antegrade Femur Piriformis Fossa Nail 13mm X
30cm Univ Ti-6Al-4V
47-2491-320-13 Antegrade Femur Piriformis Fossa Nail 13mm X
32cm Univ Ti-6Al-4V
47-2491-340-13 Antegrade Femur Piriformis Fossa Nail 13mm X
34cm Univ Ti-6Al-4V
47-2491-360-13 Antegrade Femur Piriformis Fossa Nail 13mm X
36cm Univ Ti-6Al-4V
47-2491-380-13 Antegrade Femur Piriformis Fossa Nail 13mm X
38cm Univ Ti-6Al-4V
47-2491-400-13 Antegrade Femur Piriformis Fossa Nail 13mm X
40cm Univ Ti-6Al-4V
47-2491-420-13 Antegrade Femur Piriformis Fossa Nail 13mm X
42cm Univ Ti-6Al-4V
47-2491-440-13 Antegrade Femur Piriformis Fossa Nail 13mm X
44cm Univ Ti-6Al-4V
47-2491-460-13 Antegrade Femur Piriformis Fossa Nail 13mm X
46cm Univ Ti-6Al-4V
47-2491-300-14 Antegrade Femur Piriformis Fossa Nail 14mm X
30cm Univ Ti-6Al-4V
47-2491-320-14 Antegrade Femur Piriformis Fossa Nail 14mm X
32cm Univ Ti-6Al-4V
47-2491-340-14 Antegrade Femur Piriformis Fossa Nail 14mm X
34cm Univ Ti-6Al-4V
47-2491-360-14 Antegrade Femur Piriformis Fossa Nail 14mm X
36cm Univ Ti-6Al-4V
47-2491-380-14 Antegrade Femur Piriformis Fossa Nail 14mm X
38cm Univ Ti-6Al-4V
47-2491-400-14 Antegrade Femur Piriformis Fossa Nail 14mm X
40cm Univ Ti-6Al-4V
47-2491-420-14 Antegrade Femur Piriformis Fossa Nail 14mm X
42cm Univ Ti-6Al-4V
47-2491-440-14 Antegrade Femur Piriformis Fossa Nail 14mm X
44cm Univ Ti-6Al-4V
47-2491-460-14 Antegrade Femur Piriformis Fossa Nail 14mm X
46cm Univ Ti-6Al-4V
Antegrade Femur, Piriformis Fossa Nails
Item Number Product Description
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 25
47-2483-050-60 6.0mm Cancellous Screw 50mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-055-60 6.0mm Cancellous Screw 55mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-060-60 6.0mm Cancellous Screw 60mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-065-60 6.0mm Cancellous Screw 65mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-070-60 6.0mm Cancellous Screw 70mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-075-60 6.0mm Cancellous Screw 75mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-080-60 6.0mm Cancellous Screw 80mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-085-60 6.0mm Cancellous Screw 85mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-090-60 6.0mm Cancellous Screw 90mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-095-60 6.0mm Cancellous Screw 95mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-100-60 6.0mm Cancellous Screw 100mm Length Ti-
6Al-4V Partially Threaded 3.5mm Hex Head
47-2483-105-60 6.0mm Cancellous Screw 105mm Length Ti-
6Al-4V Partially Threaded 3.5mm Hex Head
47-2483-110-60 6.0mm Cancellous Screw 110mm Length Ti-
6Al-4V Partially Threaded 3.5mm Hex Head
47-2483-115-60 6.0mm Cancellous Screw 115mm Length Ti-
6Al-4V Partially Threaded 3.5mm Hex Head
47-2483-120-60 6.0mm Cancellous Screw 120mm Length Ti-
6Al-4V Partially Threaded 3.5mm Hex Head
47-2483-125-60 6.0mm Cancellous Screw 125mm Length Ti-
6Al-4V Partially Threaded 3.5mm Hex Head
47-2483-130-60 6.0mm Cancellous Screw 130mm Length Ti-
6Al-4V Partially Threaded 3.5mm Hex Head
47-2483-135-60 6.0mm Cancellous Screw 135mm Length Ti-
6Al-4V Partially Threaded 3.5mm Hex Head
47-2483-140-60 6.0mm Cancellous Screw 140mm Length Ti-
6Al-4V Partially Threaded 3.5mm Hex Head
47-2484-050-60 6.0mm Cancellous Screw 50mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-055-60 6.0mm Cancellous Screw 55mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-060-60 6.0mm Cancellous Screw 60mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-065-60 6.0mm Cancellous Screw 65mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-070-60 6.0mm Cancellous Screw 70mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-075-60 6.0mm Cancellous Screw 75mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-080-60 6.0mm Cancellous Screw 80mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-085-60 6.0mm Cancellous Screw 85mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-090-60 6.0mm Cancellous Screw 90mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-095-60 6.0mm Cancellous Screw 95mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-100-60 6.0mm Cancellous Screw 100mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-105-60 6.0mm Cancellous Screw 105mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-110-60 6.0mm Cancellous Screw 110mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-115-60 6.0mm Cancellous Screw 115mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-120-60 6.0mm Cancellous Screw 120mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-125-60 6.0mm Cancellous Screw 125mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-130-60 6.0mm Cancellous Screw 130mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-135-60 6.0mm Cancellous Screw 135mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-140-60 6.0mm Cancellous Screw 140mm Length
Ti-6Al-4V Fixed Angle 3.5mm Hex Head
6.0mm Partially Threaded Screws (for proximal recon holes)
Item Number Product Description
6.0mm Fixed Angle Screws (for descending interlocking holes)
Item Number Product Description
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
26
47-2483-020-50 5.0mm Cortical Screw 20mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-022-50 5.0mm Cortical Screw 22.5mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-025-50 5.0mm Cortical Screw 25mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-027-50 5.0mm Cortical Screw 27.5mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-030-50 5.0mm Cortical Screw 30mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-032-50 5.0mm Cortical Screw 32.5mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-035-50 5.0mm Cortical Screw 35mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-037-50 5.0mm Cortical Screw 37.5mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-040-50 5.0mm Cortical Screw 40mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-042-50 5.0mm Cortical Screw 42.5mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-045-50 5.0mm Cortical Screw 45mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-047-50 5.0mm Cortical Screw 47.5mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-050-50 5.0mm Cortical Screw 50mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-052-50 5.0mm Cortical Screw 52.5mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-055-50 5.0mm Cortical Screw 55mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-057-50 5.0mm Cortical Screw 57.5mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-060-50 5.0mm Cortical Screw 60mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-065-50 5.0mm Cortical Screw 65mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-070-50 5.0mm Cortical Screw 70mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-075-50 5.0mm Cortical Screw 75mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-080-50 5.0mm Cortical Screw 80mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-085-50 5.0mm Cortical Screw 85mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-090-50 5.0mm Cortical Screw 90mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-095-50 5.0mm Cortical Screw 95mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-100-50 5.0mm Cortical Screw 100mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2484-020-50 5.0mm Cortical Screw 20mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-022-50 5.0mm Cortical Screw 22.5mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-025-50 5.0mm Cortical Screw 25mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-027-50 5.0mm Cortical Screw 27.5mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-030-50 5.0mm Cortical Screw 30mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-032-50 5.0mm Cortical Screw 32.5mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-035-50 5.0mm Cortical Screw 35mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-037-50 5.0mm Cortical Screw 37.5mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-040-50 5.0mm Cortical Screw 40mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-042-50 5.0mm Cortical Screw 42.5mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-045-50 5.0mm Cortical Screw 45mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-047-50 5.0mm Cortical Screw 47.5mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-050-50 5.0mm Cortical Screw 50mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-052-50 5.0mm Cortical Screw 52.5mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-055-50 5.0mm Cortical Screw 55mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-057-50 5.0mm Cortical Screw 57.5mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-060-50 5.0mm Cortical Screw 60mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-065-50 5.0mm Cortical Screw 65mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-070-50 5.0mm Cortical Screw 70mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-075-50 5.0mm Cortical Screw 75mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-080-50 5.0mm Cortical Screw 80mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-085-50 5.0mm Cortical Screw 85mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-090-50 5.0mm Cortical Screw 90mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-095-50 5.0mm Cortical Screw 95mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
47-2484-100-50 5.0mm Cortical Screw 100mm Length Ti-6Al-4V
Fixed Angle 3.5mm Hex Head
5.0mm Partially Threaded Screws (for proximal transverse
screw holes and distal screw holes in 9.3mm and larger diameter nails)
Item Number Product Description
5.0mm Fixed Angle Screws (for proximal transverse screw
holes and distal screw holes in 9.3mm and larger diameter nails)
Item Number Product Description
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 27
47-2483-020-40 4.0mm Cortical Screw 20mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-022-40 4.0mm Cortical Screw 22.5mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-025-40 4.0mm Cortical Screw 25mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-027-40 4.0mm Cortical Screw 27.5mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-030-40 4.0mm Cortical Screw 30mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-032-40 4.0mm Cortical Screw 32.5mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-035-40 4.0mm Cortical Screw 35mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-037-40 4.0mm Cortical Screw 37.5mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-040-40 4.0mm Cortical Screw 40mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-042-40 4.0mm Cortical Screw 42.5mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-045-40 4.0mm Cortical Screw 45mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-047-40 4.0mm Cortical Screw 47.5mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-050-40 4.0mm Cortical Screw 50mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-052-40 4.0mm Cortical Screw 52.5mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-055-40 4.0mm Cortical Screw 55mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-057-40 4.0mm Cortical Screw 57.5mm Length Ti-6Al-
4V Partially Threaded 3.5mm Hex Head
47-2483-060-40 4.0mm Cortical Screw 60mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-065-40 4.0mm Cortical Screw 65mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-070-40 4.0mm Cortical Screw 70mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-075-40 4.0mm Cortical Screw 75mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-080-40 4.0mm Cortical Screw 80mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-085-40 4.0mm Cortical Screw 85mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-090-40 4.0mm Cortical Screw 90mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-095-40 4.0mm Cortical Screw 95mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2483-100-40 4.0mm Cortical Screw 100mm Length Ti-6Al-4V
Partially Threaded 3.5mm Hex Head
47-2484-020-40 4.0mm Cortical Screw 20mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-022-40 4.0mm Cortical Screw 22.5mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-025-40 4.0mm Cortical Screw 25mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-027-40 4.0mm Cortical Screw 27.5mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-030-40 4.0mm Cortical Screw 30mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-032-40 4.0mm Cortical Screw 32.5mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-035-40 4.0mm Cortical Screw 35mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-037-40 4.0mm Cortical Screw 37.5mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-040-40 4.0mm Cortical Screw 40mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-042-40 4.0mm Cortical Screw 42.5mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-045-40 4.0mm Cortical Screw 45mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-047-40 4.0mm Cortical Screw 47.5mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-050-40 4.0mm Cortical Screw 50mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-052-40 4.0mm Cortical Screw 52.5mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-055-40 4.0mm Cortical Screw 55mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-057-40 4.0mm Cortical Screw 57.5mm Length Ti-
6Al-4V Fixed Angle 3.5mm Hex Head
47-2484-060-40 4.0mm Cortical Screw 60mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-065-40 4.0mm Cortical Screw 65mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-070-40 4.0mm Cortical Screw 70mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-075-40 4.0mm Cortical Screw 75mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-080-40 4.0mm Cortical Screw 80mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-085-40 4.0mm Cortical Screw 85mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-090-40 4.0mm Cortical Screw 90mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-095-40 4.0mm Cortical Screw 95mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
47-2484-100-40 4.0mm Cortical Screw 100mm Length Ti-6Al-
4V Fixed Angle 3.5mm Hex Head
4.0mm Partially Threaded Screws
(for distal screw holes in 8.3mm Greater Trochanter Entry Point nails only)
Item Number Product Description
4.0mm Fixed Angled Screws
(for distal screw holes in 8.3mm Greater Trochanter Entry Point nails only)
Item Number Product Description
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
28
47-2487-001-00 Femoral Nail Cap 0mm Height Ti-6Al-4V
47-2487-001-05 Femoral Nail Cap 5mm Height Ti-6Al-4V
47-2487-001-10 Femoral Nail Cap 10mm Height Ti-6Al-4V
47-2487-001-15 Femoral Nail Cap 15mm Height Ti-6Al-4V
00-2490-046-30 3.0mm Threaded Pin 3
00-2490-008-01 Small Antegrade Femoral Connecting Bolt 2
00-2490-031-05 11mm Hex / Pin Wrench 2
00-2490-046-20 2.0mm Pin 2
00-2490-061-80 Short Screw Cannula 10.0mm OD 8.0mm
ID
1
00-2490-081-80 Short Screw Cannula 12.5mm OD 8.0mm
ID
1
00-2490-082-80 Short Screw Trocar 8.0mm 2
00-2490-063-30 Short Guide Pin Sleeve 3.0mm 2
00-2490-000-15 Connecting Knob Radel Bushing 1
00-2490-000-30 Nail Diameter Gauge 1
00-2490-000-33 Ruler 1
00-2490-000-34 Nail Length Gauge 1
00-2490-098-10 Small Antegrade Femur Targeting Guide
Handle
1
00-2490-091-15 Small Antegrade Femur Interlock Module
- Solid
1
00-2490-091-16 Small Antegrade Femur Recon Screw Module
- Solid
1
00-2490-010-01 Short Cannulated Awl 1
00-2490-012-00 Guide Wire Gripper 1
00-2490-013-00 Entry Cannula 1
00-2490-013-01 Entry Cannula Starting Point Locator 1
00-2490-014-01 Inner Channel Reamer 1
00-2490-014-02 Channel Reamer Sleeve 14.5mm 1
00-2490-014-14 Taper Reamer 14.5mm 1
00-2490-014-80 Entry Reamer 8.0mm 1
00-2490-017-00 Guide Wire Pusher 1
00-2490-031-00 Connecting Bolt Inserter 1
00-2490-032-00 Impaction Head 1
00-2490-032-01 Slotted Mallet 1
00-2490-035-75 Freehand Mod 3.5mm Hex Screwdriver 2
00-2490-046-32 Guide Pin Inserter/Extractor 1
00-2490-047-80 Long Cannulated Depth Gauge 1
00-2490-050-02 Modular T-Handle 1
00-2490-065-80 Short Screw Depth Gauge 8.0mm 1
00-2490-070-00 Freehand Targeting Wand 1
00-2490-073-00 Freehand Targeting Depth Gauge 1
00-2490-074-00 Freehand Tissue Protection Sleeve 1
00-2490-080-00 Nail Cap Inserter 1
02.00020.049 Ratchet Wrench 11 1
Nail Caps
Item Number Product Description KT-2490-001-02 Small Antegrade Femoral Instrument Set
Instruments
Item Number Product Description
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 29
00-2490-035-60 Short Modular 3.5mm Hex Screwdriver 2
00-2490-035-62 Captured Screwdriver 3.5 Hex - Short 1
00-2490-035-72 Captured Screwdriver 3.5 Hex - Freehand 1
00-2490-080-03 Nail Cap Retaining Shaft 1
00-2490-033-00 Slap Hammer Adapter 1
00-2490-090-00 Cann Extract Adapter 5/16” 1
00-2490-000-41 Hole Indicator 2
00-2490-050-00 Modular T-Handle AO 1
00-2490-063-43 Short Drill Sleeve 4.3mm 2
00-2490-063-49 Short Drill Sleeve 4.9mm 2
00-2490-064-43 Calibrated Drill 4.3mm Short 2
00-2490-064-49 Short Calibrated Drill 4.9mm 2
00-2490-064-50 Short Calibrated Cannulated 4.9mm Drill 1
00-2490-075-33 3.3mm Freehand Drill 152.5mm 2
00-2490-075-43 4.3mm Freehand Drill 152.5mm 2
00-2490-012-30 3.0mm Threaded Pin by 305mm 3
00-2490-024-00 Reduction Finger 1
00-2490-000-14 Connecting Knob 3
00-5900-099-00 Standard Lids 2
Instrument Cases
(Select both “Stainless Steel” or both “Stainless Steel
and Aluminum” Cases)
Item Number Product Description
00-2490-082-00 Antegrade Femur Case 1 of 2 – Stainless
Steel
00-2490-085-00 Antegrade Femur Case 2 of 2 – Stainless
Steel
00-2490-082-50 Antegrade Femur Case 1 of 2 – Stainless
Steel and Aluminum (Blue)
00-2490-085-50 Antegrade Femur Case 2 of 2 – Stainless
Steel and Aluminum (Blue)
Optional Instruments
Item Number Product Description
00-2490-060-50 Short 5.0mm Tap
Ball Tip Guide Wire (available separately)
Item Number Product Description
00-2255-008-01 3.0mm x 100cm Ball Tip Guide Wire
(Non-Sterile)
47-2255-008-01 3.0mm x 100cm Ball Tip Guide Wire
(Sterile)
Tear Drop Guide Wire (available separately)
Item Number Product Description
47-2490-097-00 3.0mm x 100cm Tear Drop Guide Wire
(Sterile)
47-2490-097-01 2.4mm x 100cm Tear Drop Guide Wire
(Sterile)
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique
30
Zimmer® Natural Nail® System Antegrade Femoral Surgical Technique 31
97-2491-002-00 Rev. 3 6-17-15 2015 ©2015 Zimmer, Inc.
Contact your Zimmer representative or visit us at www.zimmer.com
The CE mark is valid only if it is also printed on the product label.
DISCLAIMER:
This documentation is intended exclusively for physicians and is not intended for laypersons. Information on the
products and procedures contained in this document is of a general nature and does not represent and does not
constitute medical advice or recommendations. Because this information does not purport to constitute any diagnostic
or therapeutic statement with regard to any individual medical case, each patient must be examined and advised
individually, and this document does not replace the need for such examination and/or advise in whole or in part.
Please refer to the package inserts for important product information, including, but not limited to, indications,
contraindications, warnings, precautions, and adverse effects.

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